title: Transient elastography to assess hepatic fibrosis in hemodialysis chronic hepatitis C patients.
abstract: OBJECTIVE
  Although percutaneous liver biopsy (PLB) is the gold standard for staging hepatic fibrosis in hemodialysis patients with chronic hepatitis C (CHC) before renal transplantation or antiviral therapy, concerns exist about serious postbiopsy complications. Using transient elastography (TE, Fibroscan(®)) to predict the severity of hepatic fibrosis has not been prospectively evaluated in these patients.
  
  
  METHODS
  A total of 284 hemodialysis patients with CHC were enrolled. TE and aspartate aminotransferase-to-platelet ratio index (APRI) were performed before PLB. The severity of hepatic fibrosis was staged by METAVIR scores ranging from F0 to F4. Receiver operating characteristic curves were used to assess the diagnostic accuracy of TE and APRI, taking PLB as the reference standard.
  
  
  RESULTS
  The areas under curves of TE were higher than those of APRI in predicting patients with significant hepatic fibrosis (≥F2) (0.96 versus 0.84, P<0.001), those with advanced hepatic fibrosis (≥F3) (0.98 versus 0.93, P=0.04), and those with cirrhosis (F4) (0.99 versus 0.92, P=0.13). Choosing optimized liver stiffness measurements of 5.3, 8.3, and 9.2 kPa had high sensitivity (93-100%) and specificity (88-99%), and 87, 97, and 93% of the patients with a fibrosis stage of ≥F2, ≥F3, and F4 were correctly diagnosed without PLB, respectively.
  
  
  CONCLUSIONS
  TE is superior to APRI in assessing the severity of hepatic fibrosis and can substantially decrease the need of staging PLB in hemodialysis patients with CHC.
authors.affiliation: Department of Internal Medicine, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Chen-Hua
authors.initials: CH
authors.lastname: Liu
authors.forename: Cheng-Chao
authors.initials: CC
authors.lastname: Liang
authors.forename: Kai-Wen
authors.initials: KW
authors.lastname: Huang
authors.forename: Chun-Jen
authors.initials: CJ
authors.lastname: Liu
authors.forename: Shih-I
authors.initials: SI
authors.lastname: Chen
authors.forename: Jou-Wei
authors.initials: JW
authors.lastname: Lin
authors.forename: Peir-Haur
authors.initials: PH
authors.lastname: Hung
authors.forename: Hung-Bin
authors.initials: HB
authors.lastname: Tsai
authors.forename: Ming-Yang
authors.initials: MY
authors.lastname: Lai
authors.forename: Pei-Jer
authors.initials: PJ
authors.lastname: Chen
authors.forename: Jun-Herng
authors.initials: JH
authors.lastname: Chen
authors.forename: Ding-Shinn
authors.initials: DS
authors.lastname: Chen
authors.forename: Jia-Horng
authors.initials: JH
authors.lastname: Kao
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D054459:Elasticity Imaging Techniques / Q000379:methods* / Q000592:standards*; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications / Q000473:pathology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008103:Liver Cirrhosis / Q000150:complications / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012015:Reference Standards; D006435:Renal Dialysis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D055815:Young Adult